scholarly journals Patients Specific Spine Simulators for Surgical Training and Rehearsal in Pedicle Screws Placement: A New Way for Surgical Education

10.29007/38mg ◽  
2020 ◽  
Author(s):  
Paolo Domenico Parchi ◽  
Sara Condino ◽  
Marina Carbone ◽  
Sara Stagnari ◽  
David Rocchi ◽  
...  
Keyword(s):  
Surgical Training ◽  
Pedicle Screws ◽  
Senior Resident ◽  
Patient Specific ◽  
Training Tool ◽  
Surgical Simulators ◽  
Timeline Analysis ◽  
Significant Difference ◽  
Ct Evaluation ◽  
3D Printed

In pedicle screws placement using a free-hand technique or a fluoroscopic guided technique the main difficulties are facing to the bone morphology (i.e in deformity cases) and it could be easily reproduced in a patient’s specific spine simulator (we can choose the case). The aim of this work is to evaluate the use of 3D printed patient- specific models (3D printing) not only as a surgical planning tool but also as a surgical training tool in spine surgery and in particular in pedicle screws placement. The manufacturing of patient-specific physical replica involves the elaboration of CT dataset and rapid prototyping techniques. . Five resident surgeons were involved in different training sessions on simulators. To evaluate the exact screws position weperformed a CT evaluation of each instrumented simulators. Statistical analysis was conducted using SPSS software. A total of 120 pedicle screws were positioned, 90 screws were well-positioned and 30 screws were bad-positioned. There were a significant difference (p = 0.000008) between the bad-positioning screw rate of the “senior” resident (13/72) and those of “young” participants (17/48). Timeline analysis of pedicle instrumentation training showed the presence of a learning effect, with a lower error rate in the latest session (p=000001). We believe that the use of patient- specific surgical simulators, especially for those surgical tasks in which the complexity is mainly linked to the spine morphology (i.e. deformity), may represent a valid alternative to the use of cadavers that generally present a standard or otherwise poorly predictable anatomy.

scholarly journals Hybrid Spine Simulator Prototype for X-ray Free Pedicle Screws Fixation Training

2021 ◽  
Vol 11 (3) ◽  
pp. 1038
Author(s):  
Sara Condino ◽  
Giuseppe Turini ◽  
Virginia Mamone ◽  
Paolo Domenico Parchi ◽  
Vincenzo Ferrari
Keyword(s):  
Augmented Reality ◽  
Low Cost ◽  
Lumbar Vertebrae ◽  
Pedicle Screws ◽  
Simulation Software ◽  
Patient Specific ◽  
Innovative Strategy ◽  
X Ray ◽  
3D Printed ◽  
Harmful Radiation

Simulation for surgical training is increasingly being considered a valuable addition to traditional teaching methods. 3D-printed physical simulators can be used for preoperative planning and rehearsal in spine surgery to improve surgical workflows and postoperative patient outcomes. This paper proposes an innovative strategy to build a hybrid simulation platform for training of pedicle screws fixation: the proposed method combines 3D-printed patient-specific spine models with augmented reality functionalities and virtual X-ray visualization, thus avoiding any exposure to harmful radiation during the simulation. Software functionalities are implemented by using a low-cost tracking strategy based on fiducial marker detection. Quantitative tests demonstrate the accuracy of the method to track the vertebral model and surgical tools, and to coherently visualize them in either the augmented reality or virtual fluoroscopic modalities. The obtained results encourage further research and clinical validation towards the use of the simulator as an effective tool for training in pedicle screws insertion in lumbar vertebrae.

Investigation of three-dimensional printing materials for printing aorta model replicating Type B aortic dissection

2021 ◽  
Vol 17 ◽  
Author(s):  
Chia-An Wu ◽  
Andrew Squelch ◽  
Zhonghua Sun
Keyword(s):  
3D Printing ◽  
Aortic Dissection ◽  
Three Dimensional ◽  
Ct Images ◽  
Patient Specific ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Ct Attenuation ◽  
Significant Difference ◽  
3D Printed

Aim: To determine a printing material that has both elastic property and radiology equivalence close to real aorta for simulation of endovascular stent graft repair of aortic dissection. Background: With the rapid development of three-dimensional (3D) printing technology, a patient-specific 3D printed model is able to help surgeons to make better treatment plan for Type B aortic dissection patients. However, the radiological properties of most 3D printing materials have not been well characterized. This study aims to investigate the appropriate materials for printing human aorta with mechanical and radiological properties similar to the real aortic computed tomography (CT) attenuation. Objective: Quantitative assessment of CT attenuation of different materials used in 3D printed models of aortic dissection for developing patient-specific 3D printed aorta models to simulate type B aortic dissection. Method: A 25-mm length of aorta model was segmented from a patient’s image dataset with diagnosis of type B aortic dissection. Four different elastic commercial 3D printing materials, namely Agilus A40 and A50, Visijet CE-NT A30 and A70 were selected and printed with different hardness. Totally four models were printed out and conducted CT scanned twice on a 192-slice CT scanner using the standard aortic CT angiography protocol, with and without contrast inside the lumen.Five reference points with region of interest (ROI) of 1.77 mm2 were selected at the aortic wall and intimal flap and their Hounsfield units (HU) were measured and compared with the CT attenuation of original CT images. The comparison between the patient’s aorta and models was performed through a paired-sample t-test to determine if there is any significant difference. Result: The mean CT attenuation of aortic wall of the original CT images was 80.7 HU. Analysis of images without using contrast medium showed that the material of Agilus A50 produced the mean CT attenuation of 82.6 HU, which is similar to that of original CT images. The CT attenuation measured at images acquired with other three materials was significantly lower than that of original images (p<0.05). After adding contrast medium, Visijet CE-NT A30 had an average CT attenuation of 90.6 HU, which is close to that of the original images with statistically significant difference (p>0.05). In contrast, the CT attenuation measured at images acquired with other three materials (Agilus A40, A50 and Visiject CE-NT A70) was 129 HU, 135 HU and 129.6 HU, respectively, which is significantly higher than that of original CT images (p<0.05). Conclusion: Both Visijet CE-NT and Agilus have tensile strength and elongation close to real patient’s tissue properties producing similar CT attenuation. Visijet CE-NT A30 is considered the appropriate material for printing aorta to simulate contrast-enhanced CT imaging of type B aortic dissection. Due to lack of body phantom in the experiments, further research with simulation of realistic anatomical body environment should be conducted.

scholarly journals Clinical Applications of Patient-Specific 3D Printed Models in Cardiovascular Disease: Current Status and Future Directions

Biomolecules ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 1577
Author(s):  
Zhonghua Sun
Keyword(s):  
Cardiovascular Disease ◽  
3D Printing ◽  
Current Status ◽  
Patient Specific ◽  
Future Research ◽  
Junior Doctors ◽  
Imaging Data ◽  
Training Tool ◽  
Complex Anatomy ◽  
3D Printed

Three-dimensional (3D) printing has been increasingly used in medicine with applications in many different fields ranging from orthopaedics and tumours to cardiovascular disease. Realistic 3D models can be printed with different materials to replicate anatomical structures and pathologies with high accuracy. 3D printed models generated from medical imaging data acquired with computed tomography, magnetic resonance imaging or ultrasound augment the understanding of complex anatomy and pathology, assist preoperative planning and simulate surgical or interventional procedures to achieve precision medicine for improvement of treatment outcomes, train young or junior doctors to gain their confidence in patient management and provide medical education to medical students or healthcare professionals as an effective training tool. This article provides an overview of patient-specific 3D printed models with a focus on the applications in cardiovascular disease including: 3D printed models in congenital heart disease, coronary artery disease, pulmonary embolism, aortic aneurysm and aortic dissection, and aortic valvular disease. Clinical value of the patient-specific 3D printed models in these areas is presented based on the current literature, while limitations and future research in 3D printing including bioprinting of cardiovascular disease are highlighted.

scholarly journals 3D Printing Custom Bioactive and Absorbable Surgical Screws, Pins, and Bone Plates for Localized Drug Delivery

2019 ◽  
Vol 10 (2) ◽  
pp. 17 ◽  
Author(s):  
Karthik Tappa ◽  
Udayabhanu Jammalamadaka ◽  
Jeffery Weisman ◽  
David Ballard ◽  
Dallas Wolford ◽  
...  
Keyword(s):  
Drug Delivery ◽  
3D Printing ◽  
Flexural Strength ◽  
Bone Plates ◽  
Patient Specific ◽  
Fixation Devices ◽  
Significant Difference ◽  
3D Printed ◽  
Localized Drug Delivery ◽  
Orthopedic Applications

Additive manufacturing has great potential for personalized medicine in osseous fixation surgery, including maxillofacial and orthopedic applications. The purpose of this study was to demonstrate 3D printing methods for the fabrication of patient-specific fixation implants that allow for localized drug delivery. 3D printing was used to fabricate gentamicin (GS) and methotrexate (MTX)-loaded fixation devices, including screws, pins, and bone plates. Scaffolds with different infill ratios of polylactic acid (PLA), both without drugs and impregnated with GS and MTX, were printed into cylindrical and rectangular-shaped constructs for compressive and flexural strength mechanical testing, respectively. Bland PLA constructs showed significantly higher flexural strength when printed in a Y axis at 100% infill compared to other axes and infill ratios; however, there was no significant difference in flexural strength between other axes and infill ratios. GS and MTX-impregnated constructs had significantly lower flexural and compressive strength as compared to the bland PLA constructs. GS-impregnated implants demonstrated bacterial inhibition in plate cultures. Similarly, MTX-impregnated implants demonstrated a cytotoxic effect in osteosarcoma assays. This proof of concept work shows the potential of developing 3D printed screws and plating materials with the requisite mechanical properties and orientations. Drug-impregnated implants were technically successful and had an anti-bacterial and chemotherapeutic effect, but drug addition significantly decreased the flexural and compressive strengths of the custom implants.

scholarly journals Use of Knee Fractures Physical Replicas for Surgical Training and Rehearsal: Proof of Concept Study

10.29007/m6wn ◽  
2020 ◽  
Author(s):  
Angelo Capodici ◽  
Paolo Domenico Parchi ◽  
Sara Condino ◽  
Marina Carbone ◽  
Vincenzo Ferrari ◽  
...  
Keyword(s):  
Surgical Training ◽  
Tibial Plateau ◽  
Training Session ◽  
3D Models ◽  
Complex Case ◽  
Patient Specific ◽  
Surgical Simulators ◽  
Surgical Complexity ◽  
Ct Segmentation ◽  
Teaching Modality

In the last years also in orthopedic surgery, there was an increasing interest in the development of surgical simulators using methods of additive manufacturing combined or not with augmented reality systems (hybrid simulators). Aim of this work was to evaluate the use of a new patient’s specific tibial plateau fractures simulator for surgical training of young resident surgeons in fracture fixation with an external fixator. The simulator is a realistic knee phantom including a patient-specific replica of a fractured tibia and fibula, obtained by CT segmentation and rapid prototyping techniques. Each training session started with the presentation, and planning, of the surgical case that it was followed by the external fixation session on the simulator. At the end of each session, all participants were asked to fill out a questionnaire, concerning the phantom realism and appropriateness as a teaching modality. The results of the Likert Questionnaire indicating that there is an overall significant agreement with the phantom realism and its appropriateness as a teaching modality.The solid model of the patient’s anatomy can faithfully reproduce the surgical complexity of the patient and it allows to generate surgical simulators with an increasing difficulty to perform structured training paths: from the "simple" case to the "complex" case. The use of simulators based on 3D models has proved to be a very useful tool both for didactic and surgical training purposes, allowing surgeons to perform a real procedure simulation outside the surgical room.

Comparison of Materials Used for 3D-Printing Temporal Bone Models to Simulate Surgical Dissection

2020 ◽  
Vol 129 (12) ◽  
pp. 1168-1173 ◽  
Author(s):  
Alexandra McMillan ◽  
Armine Kocharyan ◽  
Simone E. Dekker ◽  
Elias George Kikano ◽  
Anisha Garg ◽  
...  
Keyword(s):  
3D Printing ◽  
Temporal Bone ◽  
Surgical Training ◽  
Fused Deposition Modeling ◽  
Acrylonitrile Butadiene Styrene ◽  
Acrylic Resin ◽  
Training Tool ◽  
Fused Deposition ◽  
Cortical Mastoidectomy ◽  
3D Printed

Objective: To identify 3D-printed temporal bone (TB) models that most accurately recreate cortical mastoidectomy for use as a training tool by comparison of different materials and fabrication methods. Background: There are several different printers and materials available to create 3D-printed TB models for surgical planning and trainee education. Current reports using Acrylonitrile Butadiene Styrene (ABS) plastic generated via fused deposition modeling (FDM) have validated the capacity for 3D-printed models to serve as accurate surgical simulators. Here, a head-to-head comparison of models produced using different materials and fabrication processes was performed to identify superior models for application in skull base surgical training. Methods: High-resolution CT scans of normal TBs were used to create stereolithography files with image conversion for application in 3D-printing. The 3D-printed models were constructed using five different materials and four printers, including ABS printed on a MakerBot 2x printer, photopolymerizable polymer (Photo) using the Objet 350 Connex3 Printer, polycarbonate (PC) using the FDM-Fortus 400 mc printer, and two types of photocrosslinkable acrylic resin, white and blue (FLW and FLB, respectively), using the Formlabs Form 2 stereolithography printer. Printed TBs were drilled to assess the haptic experience and recreation of TB anatomy with comparison to the current paradigm of ABS. Results: Surgical drilling demonstrated that FLW models created by FDM as well as PC and Photo models generated using photopolymerization more closely recreated cortical mastoidectomy compared to ABS models. ABS generated odor and did not represent the anatomy accurately. Blue resin performed poorly in simulation, likely due to its dark color and translucent appearance. Conclusions: PC, Photo, and FLW models best replicated surgical drilling and anatomy as compared to ABS and FLB models. These prototypes are reliable simulators for surgical training.

Accuracy of Placement of Pedicle Screws in the Lumbosacral Region of Dogs Using 3D-Printed Patient-Specific Drill Guides

2020 ◽  
Author(s):  
Cristina Toni ◽  
Bill Oxley ◽  
Stephen Clarke ◽  
Sebastien Behr
Keyword(s):  
Cauda Equina ◽  
Three Dimensional ◽  
Clinical Signs ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Patient Specific ◽  
Inclusion Criteria ◽  
Lumbosacral Region ◽  
Dorsal Stabilization ◽  
3D Printed

Abstract Objective The aim of this study was to report the accuracy of pedicle screw placement using three-dimensional (3D)-printed, patient-specific drill guides in the lumbosacral region of dogs. Study Design This was a retrospective study. Thirty-two pedicle screws were placed in five dogs. Medical records were reviewed between November 2015 and November 2018 for dogs showing clinical signs associated with cauda equina syndrome. Inclusion criteria included preoperative magnetic resonance imaging, pre- and postoperative computed tomography (CT) and dorsal stabilization, with pedicle screws placed using 3D-printed, patient-specific drill guides and polymethylmethacrylate. Screw placement was evaluated for medial or lateral breaching on postoperative CT. Results Five dogs met the inclusion criteria. Four had degenerative lumbosacral stenosis and one had discospondylitis. All dogs had failed medical management prior to surgery. Of 32 bicortical pedicle screws placed, 30 were fully contained inside the pedicle and 2 were partially breaching the vertebral canal (less than one-third of the screw diameter). Postoperative CT revealed good alignment of L7-S1 in all planes. Conclusions This technique enabled an accurate and safe placement of pedicle screws in the lumbosacral region of dogs with lumbosacral disease. Three-dimensional, printed patient-specific drill guides are a safe and effective method of placing pedicle screws in dogs with lumbosacral disease.

A finite element study on intra-operative corrective forces and evaluation of screw density in scoliosis surgeries

2018 ◽  
Vol 232 (12) ◽  
pp. 1245-1254 ◽  
Author(s):  
Ameneh Musapoor ◽  
Mohammad Nikkhoo ◽  
Mohammad Haghpanahi
Keyword(s):  
Finite Element ◽  
Pedicle Screws ◽  
Element Model ◽  
Applied Force ◽  
Patient Specific ◽  
Scoliosis Surgery ◽  
Element Analysis ◽  
Clinical Images ◽  
Significant Difference ◽  
Screw Density

Scoliosis is an abnormal sideways curvature of the spine and rib cage, which may need surgical treatments. Most of the corrective maneuvers in scoliosis surgeries are based on surgeon’s experience; hence, there is great interest of understanding how the correction ratio can be influenced by the magnitude of forces and moments. Therefore, the objective of this study was to develop and validate a detailed finite element model of the thoracolumbar which can be used to simulate the scoliosis surgeries based on patient-specific clinical images. The validated models of five patients were carefully developed, and the surgery procedures were simulated and the corrective forces were estimated using inverse finite element analysis during the surgery. Furthermore, parametric studies including the influences of the corrective force magnitude and screw density were evaluated. The results showed that the maximum estimated correction force and moment were 173 (±55.43) N and 10.67 (±2.02) N m, respectively, which were aligned with measured clinical observations. The sensitivity analysis on the magnitude of applied force to the screws showed that correction ratio was slightly increased in level 1 (i.e. FB = 1.3 ×  F) but decreased in level 2 (i.e. FB = 1.6 ×  F). In addition, the parametric study on increasing the number of pedicle screws showed that there was no significant difference between lower and higher screw density. However, the stress distribution was significantly greater using higher screw density during correction maneuvers. In conclusion, this study shows a direct relationship between the applied force/moment and screw density and the correction ratio up to a border line which should be defined accurately. This detailed computational modeling can be used in clinic in hope of achieving the optimum outcome of scoliosis surgery using individual patient-specific characterization.

Cysto-Vaginoscopy of a 3D-Printed Cloaca Model: A Step toward Personalized Noninvasive Preoperative Assessment in Patients with Complex Anorectal Malformations

2021 ◽  
Author(s):  
Wilfried Krois ◽  
Lukas Schmölz ◽  
Michael Wagner ◽  
Peter Gröpel ◽  
Ewald Unger ◽  
...  
Keyword(s):  
Preoperative Planning ◽  
Real Life ◽  
Anorectal Malformations ◽  
Patient Specific ◽  
Training Tool ◽  
Cloacal Malformation ◽  
Preoperative Training ◽  
Real Size ◽  
3D Printed ◽  
And Training

Abstract Introduction For the classification of the complexity of cloacal malformations and the decision on the operative approach, an exact anatomical assessment is mandatory. To benefit from using three-dimensional (3D)-printed models in preoperative planning and training, the practicability of these models should be guaranteed. The aim of this study was to evaluate the quality and feasibility of a real-size 3D-printed cloaca model for the purpose of cysto-vaginoscopic evaluation. Materials and Methods We performed a 3D reconstruction and printed a real-size, rubber-like 3D model of an infant pelvis with a cloacal malformation and asked invited pediatric surgeons and pediatric urologists to perform a cysto-vaginoscopy on the model and to complete a brief questionnaire to rate the quality and feasibility of the model and to indicate whether they would recommend the model for preoperative planning and training. Results Overall, 41 participants rated the model quality as good to very good (M = 3.28, standard deviation [SD] = 0.50, on a scale from 1 to 4). The model was rated as feasible for preoperative training (M = 4.10, SD = 0.75, on a scale from 1 to 5) and most participants (85.4%) would recommend the model for preoperative training. The cysto-vaginoscopy of the model was considered as a valid training tool for real-life cases and improved the confidence on the anatomy of a cloaca. Conclusion The results of our study indicate that patient-specific 3D-printed models might be a useful tool in the preoperative evaluation of complex anorectal malformations by simulation of cysto-vaginoscopy with an excellent view on anatomical structures to assess the whole spectrum of the individual cloacal malformation. Our model might be a valuable add-on tool for specialty training in pediatric colorectal surgery.

scholarly journals Effectiveness of a patient-specific 3-dimensional printed model in Septal Myectomy of hypertrophic cardiomyopathy

2020 ◽  
Vol 36 (7) ◽  
Author(s):  
Yang Wang ◽  
Hongchang Guo ◽  
Shengwei Wang ◽  
Yongqiang Lai
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Patient Specific ◽  
Class Iii ◽  
3 Dimensional ◽  
Septal Myectomy ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
3D Printed

Objective: Advanced cardiovascular surgery in structural heart disease require accurate pre-operative evaluation. Most of non-invasive imaging technologies remain limited in two-dimensional and show insufficiency of visualization for procedural planning. The aim of this study was to discuss the value of patient-specific 3-dimensional (3D) printing in treatment of hypertrophic cardiomyopathy (HCM). Methods: Patient-specific 3D-printed models were constructed preoperatively in 12 consecutive HOCM patients which come to Beijing Anzhen Hospital for surgical treatment from October 2016 to March 2017. Image files were extracted from multi-slice computed tomography images, 3D models were constructed by the Mimics 19.0 software and generated by Objet350 Connex3 3D printer. The 3D-printed models were made with soft material that can be surgically performed. The modified Morrow myectomy of the model was performed before the operation. Clinical characters and echocardiographic parameters were recorded. Results: There was no significant difference in tissue volume between the models and specimens. Preoperative and postoperative echocardiography showed the septal thickness was reduced from 18.8±4.5 mm to 12.7±3.3 mm (p<0.001), the left ventricular outflow tract obstruction was adequately relieved (83.0±27.73 mm Hg to 8.7±6.5 mm Hg, p<0.001), and the SAM disappeared completely after the operation. Cardiac function was improved in all patients (New York Heart Association functional class III to class I/II). Conclusions: The proposed optimal 3D-modelled septal myectomy allows intraoperative monitoring of the shape and volume of the myocardium resection to achieve the ‘ideal’ interventricular septum. It eliminates obstruction in the LVOT and SAM, resulting in LV remodeling with an increase in LV end-diastolic volume and diameter at early follow-up. doi: https://doi.org/10.12669/pjms.36.7.2620 How to cite this:Wang Y, Guo H, Wang S, Lai Y. Effectiveness of a patient-specific 3-dimensional printed model in Septal Myectomy of hypertrophic cardiomyopathy. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2620 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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